Mangaluru: “The last few phone calls from my husband were filled with nothing but despair and helplessness,” says Parveen Banu, her voice cracking as she recalls the final months of Sadiq Basha’s life inside Bengaluru’s Parappana Agrahara Central Prison. “He would call twice a week, each time begging me to find a way to get him proper treatment in just any hospital as long as it is outside the jail.”Sadiq Basha, just 48, was suffering from multiple serious illnesses — conditions his wife insists “were treatable with timely medical care”. But the jail authorities, according to Parveen, ignored his slow deterioration. “He was diagnosed with diabetes in 2021 and by 2024, his sugar levels had increased so much that it had begun impacting his other organs,” Parveen says. His heart function had shrunk to 30%, she adds.Basha, and his family made multiple pleas to the prison authorities and courts but they were repeatedly ignored.In 2024, Basha moved an interim bail application on medical grounds. The National Investigation Agency (NIA), which was handling the case, opposed the plea, claiming Basha was receiving “adequate treatment” inside the jail. Prison authorities backed the agency’s stand. The prison department submitted a report saying Basha was getting “specialised medical treatment” at government-run hospitals like Victoria and Bowring. The medical officer, in his report, claimed Basha was “stable”. Both the NIA court and the Karnataka high court denied him bail.On February 2 this year, Sadiq Basha died.Sadiq Basha’s shackled feet, while he was undergoing ‘treatment’ in prison. Photo: By arrangement.Parveen has since approached the court and the Karnataka State Human Rights Commission, alleging medical negligence and denial of timely treatment. Prison records, however, are likely to categorise his death as a “natural death”, the same classification used for the overwhelming majority of deaths in Indian prisons.That classification lies at the heart of a larger question. When prisoners die after allegedly being denied timely medical care, are those deaths truly natural? And who gets to decide this, the very people who are accused of not providing timely medical care?Basha’s case is not an isolated one.Last week, another pretrial detainee, Abdul Khadar, lodged in Bengaluru Central Prison, died after spending more than 18 years in custody. Arrested in connection with the Bengaluru serial blasts case, Khadar had developed multiple health complications during his prolonged incarceration. According to his lawyer, Gangadhar, Khadar had repeatedly sought interim medical bail, but his pleas were rejected each time. “Each time we moved a bail application for Khadar, the prison authorities would assure the courts that adequate treatment was available inside jail.” In courts’ records, Gangadhar says, the prisons are well-equipped to handle ailing persons. “Yet, within days of falling ill, people simply die,” he claims.Officially, both Basha and Khadar’s deaths are likely to be recorded in the same category – as ‘natural deaths’.Deaths in prison are common, but they are very rarely properly accounted for. The National Crime Records Bureau, which records prison deaths among other statistics, has been collecting such data since 2010. NCRB’s is the only publicly available data, and it provides only a generic “cause of death” in prisons.The data broadly classifies deaths as natural and unnatural. Deaths due to illnesses or ageing are classified as “natural”, while deaths caused by suicide, assault, or atrocities inside prison fall under the “unnatural deaths” category.In 2006, following decades of advocacy by rights activists and recommendations made by the Law Commission of India (in its 152nd report), the Code of Criminal Procedure (CrPC) was amended to mandate judicial magistrate inquiries instead of executive magistrate inquiries. Section 176(1) of the CrPC was amended to Section 176(1A), making judicial magistrate inquiries compulsory in every case of death and rape in custody. The new Bharatiya Nagarik Suraksha Sanhita (BNSS), which replaced the CrPC, also makes judicial inquiry into custodial deaths compulsory. Yet even two decades after the law’s existence, these mandatory inquiries are rarely carried out. In many states, they are treated like technical requirements and still conducted by executive magistrates. In many cases of custodial violence, the families of the victims have had to approach the high courts to get the state to constitute judicial inquiries.According to the latest NCRB data (for the year 2024), 1,960 persons died in Indian jails. Of these, 1,737 deaths were attributed to “natural causes”. When reading these figures, one must keep in mind cases like those of Basha and Khadar. Unless a judicial magistrate diligently inquires into their deaths, they too will be categorised as ‘natural deaths’ in upcoming NCRB reports.The category of ‘Natural Deaths’ is further divided into deaths due to ageing and those due to illness. The NCRB report further subcategorises ‘illnesses’ as heart problems, lung problems, liver problems, kidney problems, HIV, cancer, tuberculosis, paralysis, cholera/diarrhoea, schizophrenia with epilepsy, brain haemorrhage, intestine perforation, drug/alcohol withdrawal symptoms, and others. Most of these conditions may not in themselves be inevitably fatal but if left untreated for long, could prove fatal. As is alleged in the cases of Basha and Khadar. Among all subcategorisations, the most astounding one is the ‘drug/ alcohol withdrawal symptoms’ category. This sub-category alone has recorded as many as 35 deaths in 2024. Just like in the case of other ‘natural deaths’, here too the NCRB data fails to provide any further information on whether the prisoners were receiving treatment at the time of their death, the severity of these symptoms, or any other relevant circumstances. ‘The judiciary is the custodian of the incarcerated person’The question that then arises is: Are these deaths really natural? And if they are not, who determines that they are? Is it the prison authorities against whom allegations of ill-treatment and negligence have been levelled, or the judiciary, which was approached through repeated pleas for interim medical bail but declined to grant relief? Despite the high number of custodial deaths, only a handful of cases have resulted in legal action against, or accountability for, prison officials. Nihalsing Rathod, a human rights lawyer based in Maharashtra who has handled several cases of custodial deaths and violence, says the responsibility lies squarely on both the judiciary and the state.“There is a reason why prison custody is termed judicial custody,” he points out. “As the judiciary is the custodian of the incarcerated person, isn’t it their responsibility to assess whether prisons actually have the essential facilities and to refuse to send people in custody to jail unless conditions there are improved?” Rathod asks.Rathod’s criticism of the judiciary is not merely rhetorical. Concerns over unliveable prison conditions became grounds to stall the extradition process in cases of high-profile fugitives like Vijay Mallya, Nirav Modi, and Mehul Choksi. However, Mallya, Modi or Choksi are not representative of the ordinary prisoners who make up the vast majority of India’s prison population.The Supreme Court and high courts have repeatedly emphasised that magistrates are the first line of protection for persons in custody. They are duty-bound to ensure that detainees are not subjected to torture, receive adequate medical care, and enjoy the protections guaranteed under Article 21 of the Constitution, including the right to life and the judicially recognised right to health.Prisons in India remain highly opaque institutions. What reaches the outside world is almost exclusively the version presented by prison officials. When these officials classify a death as “natural,” it is extremely difficult to uncover the truth without active judicial intervention.‘Unnatural deaths’The reasons behind “unnatural deaths” also offer critical insight into the conditions inside Indian jails. According to NCRB data for 2024, out of 166 unnatural deaths, 122 were suicides. Of the total unnatural deaths, only one death was attributed to “negligence or excess by prison officials”.While the high number of suicides reflects the severe mental distress of those in custody, the underlying causes for such an extreme act are rarely investigated. Take the case of 31-year-old Asghar Ali Mansoori, who died by suicide in Maharashtra’s Nashik Central Jail in 2020. During the post-mortem, a suicide note, naming five prison officials, was found wrapped in a polythene bag and concealed inside his abdomen. Despite this shocking discovery, no legal action has been taken against any of the officials named in the note. Five years later, Mansoori’s family continues to petition the apex human rights body and courts, seeking justice. While magistrates and trial courts, under whose orders prisoners are remanded to police and judicial custody, bear primary responsibility, high court judges in each state are also designated as “guardian judges”. They are expected to oversee the functioning of the district judiciary, including prison conditions. However, human rights organisations such as the Commonwealth Human Rights Initiative (CHRI) have repeatedly highlighted the serious lack of transparency and accountability in this system of judicial monitoring.Who do the numbers target?The consequences are visible in a prison system already stretched beyond capacity. India’s prisons operate at an average occupancy rate of over 112%. In Delhi, the figure exceeds 200%, while Uttar Pradesh, Madhya Pradesh, and Maharashtra each record occupancy rates of over 150%. At the same time, healthcare services remain severely understaffed. Against a sanctioned strength of 3,827 medical personnel, only 2,049 posts were filled as of December 31, 2024.Haryana reported the highest number of vacant medical posts (288), followed by Bihar (263) and Uttar Pradesh (224). Haryana also had the poorest prisoner-to-medical-staff ratio, with just 23 medical personnel serving 24,756 prisoners, that is, roughly one medical staff member for every 1,076 prisoners. It was followed by Maharashtra (one for every 520 prisoners), Punjab (444), Uttar Pradesh (442), and Chhattisgarh (375). Karnataka, Dadra and Nagar Haveli and Daman and Diu, and Lakshadweep reported having no medical staff at all in their prisons. Despite the gravity of these shortages, the issue rarely receives sustained attention from the courts.In February this year, opposition members created an uproar in the Chhattisgarh Legislative Assembly following the death of tribal leader Jeevan Thakur in Kanker prison. Responding to questions raised by former chief minister and senior Congress leader Bhupesh Baghel, the state government informed the House that 66 incarcerated persons had died in Chhattisgarh’s prisons between January 2025 and January 31, 2026. However, the mandatory judicial inquiry had been completed in only 18 of these cases.NCRB data, read alongside prison death statistics and the socio-economic profile of prisoners, reveals who is most often left to languish, and die, behind bars. Of the 5,11,542 incarcerated persons lodged in India’s 1,333 prisons, nearly 73% (3,71,440) are undertrials awaiting the completion of their cases.Year after year, Muslims, Scheduled Castes (SCs), Scheduled Tribes (STs), and Other Backward Classes (OBCs) remain significantly overrepresented in India’s prison population compared to their share in the general population. According to the latest NCRB data for 2024, among the 1,36,138 convicted prisoners, Muslims account for 21,640 (15.9%), SCs for 25,088 (18.4%), STs for 16,736 (12.3%), and OBCs for 43,561 (32.0%). Prisoners from the general category number 34,404 (25.3%).The disparity is even more pronounced among undertrials. Of the 3,71,440 undertrial prisoners, Muslims constitute 69,864 (18.8%), SCs 61,755 (16.6%), STs 34,154 (9.2%), and OBCs 1,10,194 (29.7%), while those from the general category account for 1,00,288 (27.0%).Prison deaths reflect the same pattern. It is the socially and economically marginalised who are disproportionately represented among those who die in custody. As long as deaths in custody are not routinely investigated and subjected to rigorous independent judicial scrutiny, the deaths of prisoners such as Sadiq Basha and Abdul Khadar risk being reduced to a statistical category of ‘natural deaths’.